Is Vaping a cloudy concept for you? Fear not! Dr. Allison Heinly joins the show to share all you need to know about screening for vaping and e-cigarette use, nicotine replacement therapy, and e‐cigarette vaping‐associated lung injury. Take a listen – you’ll be mist-ified by all you learn!
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Dr. Allison Heinly is a pediatrician and Assistant Professor of Pediatrics at Hasbro Children’s Hospital. She is an excellent teacher and has been selected twice for the Dean’s Excellence in Teaching Award for the Alpert Medical School of Brown University. Her career interests are in medical education and tobacco cessation/vaping, a topic which she teaches us all about in this episode!
We don’t love using brand-names at the Cribsiders, but there’s no getting around this one: Juul is probably the most popular nicotine-containing product for teens today. It is a USB-style device that is easy to hide and vaporizes a “juice.” The “juice” includes water, flavoring, a humectant, and nicotine, particularly nicotine salt. The nicotine salt used is less irritating, but increases the addictive potential. Each Juul pod contains about 200 puffs, which is about the equivalent nicotine of a pack of cigarettes.
There are many flavors of vaping, like mango and creme-brule. Flavors make vaping more attractive to children. Flavors were banned by the FDA in 2020 in pod-based devices (like Juul), but are still allowed in disposable and reusable e-cigarettes. A notable exception to the flavor ban is menthol, which disproportionately affects communities of color (Delnevo, et al.; 2017)(Smiley et al., 2021). The FDA recently announced a plan to ban all menthol cigarettes and flavored cigars!
There are helpful checklists to screen for addiction out there, like the “Hooked on Nicotine” checklist and others. Some good questions to ask include:
There are first, second, and third-hand risks intrinsic to vaping, but the long-term health effects are not yet known. E-cigarette lithium batteries can explode and cause burns or death. Less than half a teaspoon of vaping liquid can be fatal to a toddler if ingested (Cameron et al., 2014).
Teens who vape have an increased risk for cough, wheezing, chronic bronchitis, and asthma exacerbations (National Academies of Sciences, Engineering and Medicine; 2018). This may be partly due to the inhalants in e-cigarettes and vaping devices, which include acrolein and formaldehyde (known cardiovascular toxins) and the heavy metals like tin, nickel, or lead from the coils used in many devices. We also don’t know how vaping affects the developing brain, especially with regards to mood and learning.
Teens who vape are at risk for nicotine addiction, and the younger the addiction starts, the harder it is to quit down the road. Vaping increases the odds of children moving on to combustible (conventional) cigarettes 3.5-fold, as well as the risk of using marijuana (Soneji et al., 2017, Park et al., 2020).
Motivational interviewing has been shown to lead to future quit attempts (Catley et al., 2012)
Nicotine replacement therapy (NRT) is off-label for children; however, it is supported by the American Academy of Pediatrics (AAP) because it is safe and effective. It can take 2-4 months to quit effectively using NRT. NRT significantly increases quit rates in adults (Barua et al, 2018)
NRT is titrated based on how many cigarettes a patient smokes per day, however it is hard to tell how much nicotine is being used with vaping. 1 pod per day is equivalent to 1 pack per day (20 cigarettes). The Hooked on Nicotine Checklist can help differentiate between moderate and severe addictions.
For the PATCH:
For the GUM or LOZENGE :
Note that in adults, quitting smoking by vaping is not a proven technique, but is sometimes tried. However, vaping is NOT a recommended way to help teens quit traditional cigarettes and tobacco products.
Young people who use e-cigarettes were about 5x more likely to be diagnosed with COVID, but the link is unclear (Gaiha et al., 2020). We don’t have clear data on vaping, but smoking combustible cigarettes particularly increases the risk of severe COVID illness (Lowe et al., 2021).
EVALI can mimic the flu, COVID, bacterial pneumonia, and many other things. Make sure you’re asking about vaping when taking a history! There are a variety of presenting symptoms:
Not much, to be honest… but we do know a bit:
Listeners will understand how e-cigarette use affects young people and how to support quitting nicotine in all populations.
After listening to this episode listeners will be able to…
Dr. Heinly reports no relevant financial disclosures. The Cribsiders report no relevant financial disclosures.
Ward B, Kelly J, Heinly A, Masur S, Cruz M, Chiu C, Berk J. “De-mist-ifying Vaping”. The Cribsiders Pediatric Podcast. http://www.thecribsiders.com/ September 15, 2021
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